HomeMy WebLinkAboutWillett JUDITH T. TERRY - ° �
�;' '�,�`,.� Town Hall, 53095 Main Road
TOWN CLERK ;� ,11L :� P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No: 1581-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WILLETT, ERNEST
Mailing Address 1 1800 NAUGLES DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1800 NAUGLES, DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8280
Tax Map No. section 99.00 block 5 lot 23.000
Cross Street BREAKWATER ROAD
Date Of Last Pump Out 0/00/70
Issue Date: 1/17/91 ' �M..
Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• ...
OFFICE OF THE TOWN CLERK c�VFFU(,(--'-
Town of Southold r_ C�lj Application No. tS '7
Judith T. Terry, Town Clerk .y►' w :
- 11‘) $10.00 - Residential
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P. O. Box 1179
Town Hall, 53095 Main Road "{; .
r' '"`�el ` $25.00 - Non-Residential
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Southold, New York 11971 .`�
Telephone 0,( ‘ge
(516) 765-1801
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /(/o'Z l't'O
•
'OWNER NAME: 71-,/,1W •
OWNER MAILING ADDRESS: /f6
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OWNER-PROPERTY ADDRESS.;
OWNER TELEPHONE"NUMBER: -9feZ ��
TAX.MAP NO. : Section 9 2 Block Lot a-3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / ' 7 ? D
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
C
Signature of Applicant
RECEIVED BY:
o n Clerk's Office
DATE: l//9,
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